FAQ Topic: How We Work

How does Fistula Foundation make sure my donation is used as intended?

We are committed to getting as much money as possible to our trusted partners in the field, because that’s where women’s lives are changed. 

To ensure funding goes to the most respected local doctors and hospitals in Africa and Asia, Fistula Foundation issues grants on an invitation-only basis. Learn about our partner selection process

Surgeons and hospitals that receive funding from Fistula Foundation are required to provide quarterly progress reports detailing their project activities and costs, surgical outcomes, and any challenges encountered. Fistula Foundation only releases funds once a partner’s report has been reviewed by our Medical Advisor and Program Development staff.

How much does it cost to treat obstetric fistula?

The average cost per patient is $619 USD. This includes surgery, postoperative care and physical rehabilitation. This price estimate is based on data reported to Fistula Foundation by our grantees across Africa and Asia. Costs and hospitalization can, however, be far greater for more complicated surgeries such as treating dual vaginal and rectal fistulas. You can learn more about how we determine the average cost of care on Our Strategy page

How do you determine the $619 USD cost for fistula repair surgery?

Fistula Foundation arrives at an average cost for one surgery based on aggregate data from impact and financial reports received from partners we fund across Africa and Asia. Actual surgical costs vary depending on the local economies where our partners work. Costs for more complicated surgeries, such as treating dual vaginal and rectal fistula, can be greater. Learn more about the cost of care on Our Strategy page

What type of projects does Fistula Foundation fund?

We are committed to helping women with fistula and untreated tears, both in the short term by providing as many cost-free surgeries as possible, and in the long term through our proven evidence-based strategy to eliminate these conditions for good on a country-by-country basis.

Goal 1: Strengthen local capacity at individual hospitals in Africa and Asia to treat as many women as possible

Our first goal is to provide immediate relief to women in areas of the greatest need. Rather than working through intermediaries, we partner directly with established, in-country hospitals and surgical teams who understand how best to serve women in their communities. In addition to paying for the direct costs of fistula and tear repair surgery, we strengthen the efforts of these local experts, equip hospitals to provide high-quality care, and use grassroots community outreach to reach as many suffering women as possible. This strategy has proven effective for over a decade since we first adopted a global mission in 2009. Learn more about our Investment Areas

While our primary aim is to help hospitals provide regular, continuous fistula services, in extreme cases where conditions on the ground do not permit this, we will cover the cost of a visiting surgeon, if this is the only way women in a region can access surgery. A powerful example of this “camp” model is our work in Sudan’s Nuba Mountains, an area crippled by a severe shortage of medical professionals and brutal bombings from the country’s corrupt government.

Goal 2:  Use our evidence-based countrywide treatment model to eradicate fistula country by country

Our second, longer-term goal is to eradicate the scourge of fistula globally. Fistula Foundation’s proven countrywide treatment model—with adequate backing—can end fistula in a generation on a country-by-country basis. The results of our rigorous and successful 6-year program in Kenya demonstrate that this model has the power to reach women in previously unreachable places and draw down a country’s backlog of untreated fistula and severe perineal tear cases.

This model harnesses the power of local stakeholders to develop a strong network of well-equipped hospitals across the country. These facilities are staffed by well-trained surgeons and nurses, sharing the resources and best practices needed to provide free, year-round fistula care. We collaborate with local grassroots organizations and government agencies to provide local health workers and outreach teams with the resources they need to educate communities about fistula and refer patients to a hospital in our network. With access to more treatment centers in more places, women are no longer put on a waiting list for surgery or forced to travel long distances to receive high-quality fistula care. Our countrywide network model also helps “build the bench” by training more fistula surgeons to internationally accredited standards, and helps women build a new life after fistula with psychological counseling and economic empowerment.

Following our successful Kenya pilot, launched in 2014, we secured funding in 2017 to set up a second countrywide network in Zambia. Today both programs are thriving. We are eager to roll out this path-breaking model to new countries across Africa and Asia. Our criteria for potential new networks are that the country has a high unmet need for fistula treatment and an existing foundation of surgery providers. Within that framework, there is much work to be done.




Why don’t you focus on prevention?

There were a number of worthy approaches we could have pursued in the fight against fistula, including midwifery training, contraceptive provision, and eliminating child marriage. But one path—providing curative fistula surgery—stood out from these approaches with two clear advantages: 

  • the unmet need to treat women already  injured with fistula is profound
  • the marginal difference surgery can provide is truly life-changing.

This enormous return on investment is precisely why Fistula Foundation focuses solely on delivering fistula repair surgery. With each surgery we provide, we know that we’re helping change one woman’s world forever. And we know that the ripple effect of her restored health—on both her family and community—is profound. Learn more about Our Strategy

How does Fistula Foundation choose its partners?

We do our homework upfront and only invite funding requests from the very best hospitals and doctors, some of whom operate in the world’s toughest neighborhoods. We never lose sight of the fact that we’re not buying widgets—we’re selecting surgeons to perform intricate, vaginal surgery on horribly injured women.  Cost is not the key variable; the quality and training of the medical team is.  

We vet potential partners through a careful process that draws on the expertise of the Foundation’s Program Development team, Board of Directors, and Grants Review Committee. We also rely on our relationships with the International Federation of Gynecology and Obstetrics (FIGO), Direct Relief, and an international network of fistula surgeons who help advise on the reputations of local doctors and the needs that exist in different regions.

We currently partner with 60 carefully vetted hospitals and surgical teams in 24 countries. We have worked with these partners for on average six years. Every day, these extraordinary doctors are hard at work across sub-Saharan Africa and Asia, helping women in the world’s poorest regions, some in war zones. These heroes are people like 2018 Nobel Peace Prize winner Dr. Denis Mukwege, who treats women injured by violence and childbirth in his native Democratic Republic of the Congo; midwife Edna Adan who runs a maternity hospital built with her own life savings and which today shines as a beacon of hope in Somaliland, one of the hardest places to be a woman; and an all-female team of fistula surgeons at Cure Hospital, run by Be Team International in Afghanistan, where cultural norms can significantly constrain the delivery of maternal health services and a woman may have no choice but to go without treatment if a female doctor is not available.

How do you find out about new funding opportunities?

We fund projects on an invitation-only basis, and we’re constantly on the lookout. We are in frequent conversation with our international network of surgeons and partner organizations.

How long does it take for a partner to receive funding?

We work fast, because it helps our partners more if they receive their funding quickly. Following a few protocol procedures including Board approval and the signing of a grant agreement, we usually turn around and dispense funds in about 2 months, though we can, and do. respond quickly to emergencies in a few days time if needed.

This means that if dedicated surgeons in developing countries come to us for help, we can respond immediately. For example, when Dr. Denis Mukwege, founder of the Panzi Hospital, desperately needed funds after a major donor pulled out, we could respond in a heartbeat. Panzi Hospital remains the leading treatment center for victims of sexual violence in the Congo, including surgical treatment of fistulas.

How did Fistula Foundation start?

Fistula Foundation was founded in 2000 as an all-volunteer organization to support the pioneering Addis Ababa Fistula Hospital in Ethiopia.

Our success between 2004 and 2008 enabled us to dramatically expand our mission in 2009  to fight fistula globally. As a result of this rapid expansion, we have now supported fistula treatment in 33 countries at sites on two continents, Africa and Asia. We fund more obstetric fistula surgeries globally than any other organization.

Does Fistula Foundation provide funding for the Hamlin Fistula Hospitals in Ethiopia?

Fistula Foundation began as a fundraising organization for Hamlin Hospitals and is honored to have provided over $10 million USD in support of Hamlin. Today Fistula Foundation no longer solicits earmarked funds for Hamlin Hospitals, which now runs its own fundraising operations in the U.S., Hamlin Fistula USA. Hamlin Hospitals also has partner organizations in Australia, the UK, the Netherlands, Germany, Sweden, New Zealand and Japan.

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